Evidence Supporting Routine Polysomnography Before Bariatric Surgery

Background: Obstructive sleep apnea (OSA) is common in morbidly obese patients, with a reported prevalence from 12 to 40%. Preoperative diagnosis of OSA is important for both perioperative airway management and the prevention of postoperative pulmonary complications. BMI has been reported to be an independent risk factor, and has been used recently in scoring systems to help predict OSA. Our hypothesis was that OSA is highly prevalent in patients presenting for bariatric surgery, and that BMI alone is not a good predictor of the presence or absence of sleep apnea. Methods: A cross-sectional study was undertaken of the last 170 consecutive patients presenting for bariatric surgery in a single surgeon's practice. Clinical and demographic data were available from our prospective database, and polysomnography results were reviewed retrospectively. Sleep apnea was noted as present or absent, and graded from mild to severe. The patient population was stratified by BMI into severely obese (BMI 35-39.9), morbidly obese (BMI 40-49.9), super-obese (BMI 50-59.9), and super-super-obese (BMI ≥ 60). Results: OSA had been diagnosed before surgical consultation in 26 of the 170 patients (15.3%). Sleep studies were not available in 7 patients (4.1%). The remaining 137 patients (80.6%) had sleep data available, and 105 (76.6%) had sleep apnea (based on American Board of Sleep Medicine criteria).There was no correlation of sleep apnea with BMI. The overall prevalence of OSA in this cohort was 77% (131/170). Conclusions: In this large patient cohort, sleep apnea was prevalent (77%) independent of BMI, and most cases were not diagnosed before bariatric surgical consultation.These data support the use of routine screening polysomnography before bariatric surgery.     

5-Millimeter Trocar-Site Bowel Herniation Following Laparoscopic Surgery

Background and Objectives:

This is a case report of a 5-mm trocar-site large bowel herniation following laparoscopic tubal sterilization. During laparoscopic sterilization, the 5-mm port site was closed initially. Large bowel herniation was recognized at the end of the case and managed immediately by laparoscopically reducing the hernia and closing the port site without any short- or long-term complications. Trocar-site bowel hernia is a rare complication after laparoscopic surgery. It is usually associated with trocar size >10mm. We describe a case of bowel herniation through a 5-mm trocar site, which was managed after laparoscopic surgery.

Case Report:

A 36-year-old multigravid patient underwent a laparoscopic tubal fulguration. Two 5-mm ports were used for the procedure. At the end of the procedure, the lateral trocar site was found to have fat protrusion that looked like appendices epiploicae. A laparoscopic camera was reintroduced into the abdominal cavity that showed a large bowel herniation through the 5-mm lateral port site. The hernia was reduced laparoscopically, and the fascial defect was repaired.

Conclusion:

Bowel herniation can occur through a 5-mm port. All port sites should be closed to avoid such complications.     

Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-analysis

World Journal of Surgery - Prehabilitation prior to major surgery has increased in popularity over recent years and aims to improve pre-operative conditioning of patients to improve post-operative...     

Binge Eating in Gastric Bypass Patients Before Surgery

Background: Binge eating in the obese, specifically those undergoing bariatric surgery, has only recently been investigated. This study is a continuation of a long-term effort to determine the impact of eating disorders on the outcome of bariatric surgery. Methods: Self-report questionnaires (Binge Eating Scale, Beck Depression Inventory, Questionnaire on Weight and Eating Patterns) were completed by 125 patients preparing to undergo gastric bypass surgery. Results: Binge eating was clearly a problem in this population, with 33.3% showing severe binge eating problems on the Binge Eating Scale. Over half of patients engaged in bingeing or grazing, most reporting a frequency of two or more times per week. A high level of depression was associated with binge eating. Conclusions: Because postsurgical long-term weight loss maintenance is contingent on modifying eating behavior, the identification and treatment of such disorders may be critical to successful long-term outcome in these patients.     

口服不同浓度剂量甘露醇清洁肠道效果观察

目的探讨口服不同浓度甘露醇液清洁肠道的效果,找出合适浓度和剂量.方法将腹部X线摄片(198例)和纤维结肠镜检查的(102例)门诊病人,分别随机分为三组.1组均口服6.7%甘露醇溶液750ml,2组均口服10.0%甘露醇溶液1000ml,3组均口服12.0%甘露醇溶液1 250ml.结果腹部摄片病人显影清晰度1组与2、3组比较,差异有显著性意义(均P＜0.01);结肠镜检查病人肠道清洁程度1组与2、3组比较,差异有显著性意义(均P＜0.01);不良反应发生率1、2组与3组比较,差异有显著性意义(均P＜0.01).结论口服10.0%甘露醇溶液1000 ml,肠道清洁效果好且不良反应少.     

口腔修复前行牙周整复术治疗的效果

分析在口腔修复前接受牙周整复术治疗的效果。方法 选取2022年1月-12月于我院接受口腔修复治疗的100例患者为研究对象,随机分为对照组和观察组,每组50例。对照组给予常规牙冠修复术治疗,观察组给予牙周整复术治疗,比较两组临床疗效、牙周探诊深度（PD）、附着丧失水平（AL）、口腔功能及不良反应发生情况。结果 观察组治疗总有效率为96.00%,高于对照组的60.00%（P ＜0.05）;观察组治疗后PD、AL均优于对照组（P ＜0.05）;观察组口腔功能评分均高于对照组（P ＜0.05）;观察组不良反应发生率为2.00%,低于对照组的20.00%（P ＜0.05）。结论 在口腔修复前接受牙周整复术能够获得确切的治疗效果,可有效改善患者牙周指标和口腔功能,有利于控制不良反应发生几率,值得临床应用。     

口腔修复前行牙周整复术的效果

目的 探究口腔修复前行牙周整复术的效果。方法 选取我院2020年1月-2022年12月收治的行口 腔修复的76例患者作为研究对象,随机分为对照组和观察组,每组38例。对照组给予常规修复,观察组在 口腔修复前行牙周整复术,比较两组口腔功能、恢复优良率、不良反应发生率、牙周探诊深度、牙周附着 水平以及牙龈萎缩率。结果 观察组口腔功能各项评分均高于对照组,差异有统计学意义（P＜0.05）;观察组 恢复优良率高于对照组,差异有统计学意义（P＜0.05）;观察组不良反应发生率低于对照组,差异有统计学意 义（P＜0.05）;观察组治疗后牙周探诊深度、牙周附着水平均优于对照组,差异有统计学意义（P＜0.05）; 观察组牙龈萎缩率低于对照组,差异有统计学意义（P＜0.05）。结论 在口腔修复前行牙周整复术非常关 键,可以有效改善患者口腔功能,提升恢复优良率,还可以改善患者牙周探诊深度、牙周附着水平,降低 牙龈萎缩发生率,值得临床应用。     

Mechanical Bowel Preparation in Intestinal Surgery: A Meta-Analysis and Review of the Literature

Introduction  Despite several meta-analyses and randomized controlled trials showing no benefit to patients, mechanical bowel preparation (MBP) remains the standard of practice for patients undergoing elective colorectal surgery. Methods  We performed a systematic review of the literature of trials that prospectively compared MBP with no MBP for patients undergoing elective colorectal resection. We searched MEDLINE, LILACS, and SCISEARCH, abstracts of pertinent scientific meetings and reference lists for each article found. Experts in the field were queried as to knowledge of additional reports. Outcomes abstracted were anastomotic leaks and wound infections. Meta-analysis was performed using Peto Odds ratio. Results  Of 4,601 patients (13 trials), 2,304 received MBP (Group 1) and 2,297 did not (Group 2). Anastomotic leaks occurred in 97(4.2%) patients in Group 1 and in 81(3.5%) patients in Group 2 (Peto OR = 1.214, CI 95%:0.899–1.64, P = 0.206). Wound infections occurred in 227(9.9%) patients in Group 1 and in 201(8.8%) patients in Group 2 (Peto OR = 1.156, CI 95%:0.946–1.413, P = 0.155). Discussion  This meta-analysis demonstrates that MBP provides no benefit to patients undergoing elective colorectal surgery, thus, supporting elimination of routine MBP in elective colorectal surgery. Conclusion  In conclusion, MBP is of no benefit to patients undergoing elective colorectal resection and need not be recommended to meet “standard of care.” Paper presented at the 49th Meeting of the Society for Surgery of the Alimentary Tract, San Diego, CA, USA, May 21st. Grant support and other assistance: none received.